Practical Observations in Surgery and Morbid Anatomy; Illustrated by Cases, with Dissections and Engravings

We have seen many persons who had travelled from *s Dan to Beersheba"?nay, who had circumvolved the greater part of this globe, without meeting a single incident that could elicit a remark?a single object that could excite a sensation beyond what would have been felt at their own fire-sides at home. So in the medical world, we daily observe men who have been, year after year, in full practice, without encountering a disease that required the exertion of a thought, beyond the number of draughts, or size of mixtures to be thrown in; without seeing a phenomenon beyond the pale of Cullen's descriptions ;


experience !
These remarks are called forth by the volume before us, which evinces, in every page, the unwearied industry of its author in watching the phaenomena of disease, and recording in the language of truth and simplicity their ever varying forms. Rarely indeed have we seen such an immense body of interesting facts collected into an equal space, as Mr. Howship's work presents; and he who neglects to make himself acquainted with the histories and morbid dissections here recorded, deprives himself of a fund of information which years of personal experience, even on the most extended scale, cannot counterbalance.
Mr. Howship has not only watched the changes of disease at the bed-side of sickness, but has been permitted to avail himself of other sources of information most interesting and valuable?namely, the selection of such cases and appearances of disease as were most to his purpose, from the extensive collection of preparations and their histories, preserved in the invaluable museum of his celebrated friend and patron Mr. Heaviside. The value of this permission has been enhanced by the unrivalled power of Mr. Howship's pencil, in delineating the difficult features of Morbid Anatomy, the importance of which is such, that, as Mr. H. justly observes, it may be compared to the Sun, which diffuses an equal and steady light over every path. The Physician or Surgeon, whose steps are not guided by this light, is liable every hour to wander in darkness and error; hence the importance of connecting the phenomena of diseases during life with the post mortem appearances.
Mr. Howship has adopted the arrangement of Sandifort in his Museum Anatomicum, which is the order followed in Mr. Heaviside's Museum ; namely, according to the natural situation of parts. This work contains the detail of more than one hundred and twenty interesting cases and dissections; it consequently defies regular analysis, and permits us only to offer samples of the materials with which so vast a magazine is stored. ^ Case I. [Case 5 in the work.] Anchylosis of the Jaws.
-the wonderful power of the constitution in compensating for natural defects, or artificial derangements, is here strikingly exemplified. Robert Kilveroy, aged 56 years, had been totally unable to move his jaws from the age of four years! The anchylosis was brought on at that early peri??d by violent inflammation on both sides of the face, followed by exfoliations from about the articulation of the lower jaw. He never expeiienced a day's sickness for fifty years, although there was no mastication of his food during all that period. In eating, he was in the habit of thrusting in his food with his fingers, by the left side of his mouth, where several of the teeth were deficient. A plate of the anchylosis is presented.
Case II. [8.] Large Ossific Tumour of the Face. (Preserved in Mr. Heaviside's Museum.) Eleanor Allvvay, ret. 30, was admitted into the Westminster Hospital in 1783, with a most extraordinary swelling on the right side of the face, producing great distortion, but no discolouration of the skin. The base of the tumour reached from the eye to the chin; the angle of the mouth depressed, and thrown out of its line; the nose pressed aside. The tumour projected four inches beyond the general line of the facial bones. The affection had extended across the roof of the mouth and boney palate, nearly to the opposite teeth. It was very large and fleshy. The teeth of the upper jaw, thrown out of their natural situation, formed an angle with the remaining part of the alveolar circle; and all those teeth involved in the extent of the tumour, were thus forced into the middle of the mouth, greatly impeding deglutition. This terrible disease had begun about five years before, with a small soft swelling " Not having yet reached his twentieth year, the setting in an artificial palate has been postponed ; in consequence of which circumstance, his expression in speaking is still somewhat indistinct." p. 39-This is a gratifying example of the triumph of art over the aberrations of Nature.
In May, 1814, Mr. Hovvship performed an operation nearly similar to the above, and with similar success.
After relating several interesting cases of Sanguineous Apoplexy, (none of which we shall quote, in consequence of the large space allotted to this subject in our late commentaries on Morgagni) Mr. Howship concludes, that nine cases in ten of apoplexy are occasioned by effusion of blood into or upon some part of the brain. Effusion of lymph or serous fluid upon the surface of the brain in adults is, he thinks, generally speaking, more apt to connect itself with violent head-ach ; or, in its more advanced stages, convulsion. Where extreme severity of pain in the head has preceded an attack of paralysis, the case is more hopeless than where the palsy has come on unaccompanied with that symptom; for where no pain has been felt in the head, or only a temporary sense of giddiness, the probability is, that the paralytic affection may be the result of a mere effusion of blood upon the brain; an accident to which we occasionally find the brain able to accommodate itself, so that with the assistance of proper treatment, the functions of the nervous system are restored, and the patient, more or less, perfectly recovers.
When, however, violent pains in the head have been the precursors of the attack, there is great reason to dread the existence of inflammation of the membranes of the brain connecting itself with effusion either of serum or pus, neither of which events, when dependent on an internal cause, have ever yet been proved by subsequent dissection, to be compatible with the recovery of the patient.
Case IV. One of the most extraordinary instances of what the brain will sometimes bear in the way of injury and pressure from effused blood, is said to have occurred in the late Mr.
, the most famous comedian of his day, who two years before his death had a fit of apoplexy, in consequence of which he partially lost the use of his left side, but in a few months recovered sufficiently to return to the stage, and to command the admiration of the audience to as unlimited an extent as ever. He continued performing until he suffered the second attack, which proved fatal. " On examination of the head, the seat of the first injury was readily discovered; an apoplectic cyst was found extending the Q blood taken away, to relieve her head. Her limbs became swelled with anasarca. By adopting a change of measures, however, these consequences of extreme debility were removed. " The necessity for this frequency of bleeding, was considered the more remarkable, because her habits were known to be constantly those of extreme temperance. " In January, 1813, she had been very low, and had for some days, suffered greatly from the pain in her head. On the Sunday she attended church; but on returning home, said she was very ill, and wished very much to lose some blood. In retiring to her chamber, she told her waiting maid, that she had a severe pain at her heart, and about the shoulders, and that she was persuaded, from the strangeness of her sensations, she was struck with death. She lay down upon the bed, to compose herself; and her attendants were struck with astonishment and terror, on finding, soon afterwards, that she was not asleep, but dead. " The apothecary in attendance had been with all haste sent for, but came too late. As, however, it appeared proper at least to attempt something, he opened a vein in the arm ; but no blood followed.
Examination. " Upon opening the head, all that I could observe was an excessive fulness of the vessels in general; both arteries and veins upon the pia mater ; and also a certain degree of serous effusion under the tunica arachnoidea, between the convolutions of the brain. The quantity of this serous fluid was altogether, I think, about equal to an ounce. " The whole of the brain was examined with attention, but the structure appeared to be perfectly sound. " In the ventricles there was no accumulation of fluid whatever. " In the thorax the appearances were those of health; nor were there any traces of disease to be found about the viscera of the abdomen." p. 7 1.
Case VI. Convulsion with extreme Debility, treated successfully by Depletion. Mrs. C. a soldier's wife, aetat. 28, small, delicate; was exposed, in the severe winter of 3808, for several days ana nights, to cold and snow, with an infant at the breast. She performed a long journey, and was several times nearly overwhelmed in the snow. Previously to this she had been shipwrecked, and narrowly escaped with life. Having reached Scarborough, where her husband and family resided, her disorder seemed to be merely exhaustion. The pulse was small, low, and slow; the skin cold, and pale; tongue clean and moist; appetite trifling ; head-ache ;want of sleep. To restore the balaqce of the circulation, small doses of antimony were exhibited, and repose enjoined ; but the latter injunction was not complied with. fell suddenly down, and was found insensible on the floor.
She was carried to bed, where she lay tranquil, as if asleep. The face was pale, sunk, and cold, with occasional tremors of the facial muscles,. Evening. Still insensible ; occasional contractions of the muscles of the limbs, when the pulse became sensibly harder. In half an hour after this, she revived, and complained of excessive darting pains in the head and eyeballs. Could, not bear the light; roaring noise in the ears; countenance still sunk ; complexion, paleness itself. About three ounces of blood were, with difficulty, abstracted from the arm; a similar quantity was obtained from the other arm. She felt materially relieved. In an hour, she was seized with a rigor and shivering resembling the fii>t stage of ague, which went off in half an hour. Head shaved and covered with a blister. Thirty drops of laudanum procured her some sleep. Next morning she was something better ; purged with senna and salts. In the evening, her eyes closed on a sudden ; her limbs became rigid ; and she was repeatedly convulsed. The convulsion subsiding, she complained again of noise in the head, and extreme sensibility to light. The head-ache is not, as before the bleeding, constant, but transitory and darting. She feels marks of reaction, which, in my opinion, may be much more justly considered an effort of Nature to reassume her proper functions in the ceconomy, than as evincing any disposition to disease."